America: The Decline

The Five Percent Phenomenon


See the big fat man and the monkey girl

Come see the big fat lady

Gator slim with the alligator skin

Come see the Devil Baby

(Mark Knoffler)

These summer jobs taught me great respect for how difficult the dining and restaurant business is, along with an absolute certainty it was an industry I would never work in when I became an adult. The hours are long, the pace is fast and because when people go out to dine they expect prompt service along with good food. TIPS, in fact is shorthand for: To Insure Prompt Service, a term that some modern day waiters and waitresses should revisit as not necessarily meaning DTRMG: Destined to Receive a Mandatory Gratuity.

Alternatively, it is not uncommon for me to go to a restaurant only to be immediately assaulted by a waiter or waitress who says:

“Can I bring you a drink? Do you know what you want? Can I put your appetizer and food order in? Do you know what you want for dessert?”

I say:

“No thanks. Just bring me the bill and I’ll be on my way.”

Having to wait on people also taught me early in life the polar extremes that human behavior can exhibit as it falls between the broad range of absolute pleasantry to utterly obnoxious. Dealing with the general public is the most difficult job of all, no matter what you do.

It is axiomatic in Medical Management that 5 % of the physicians on any given medical staff cause 95% of the quality or behavioral problems. This is probably a blessing considering that this statistic undoubtedly falls far below the same ratio existing in the general public. But then again, we hold professionals to higher standards than we hold ourselves.

I cannot even guess what the general public’s substandard quality or obnoxious behavioral ratios might be, but I have reason to believe that year after year in the United States they seem to be growing exponentially. It seems that as our society has become more affluent we have become a nation of people that at the same time not only has failed to become smarter but rather in conjunction with this fact of intellectual mediocrity have become a nation of greedy pseudo-sophisticates.

We have also become a nation of individuals who excel at performing substandard work, with a penchant at best to only pay  jobs lip service to their jobs, not to mention a laconic distaste for adding  any effort to address customer service issues.

We all seem to want more and more materialistically, while in a convoluted way think we deserve more and more as we simultaneously eschew giving anything back. We have become individually very self-centered selfish, uncompassionate, and seem to be on a mission to seek perfection where none can ever exist. In general Americans have become a people excelling in rudeness, lacking in manners and are passing this torch to a generation of children who in taking our lead on both counts are becoming even better at it than we are.

We also seem to excel in pretending to know a great deal more than we really do, and have no problem demonstrating our stupidity to others. Half the people interviewed on the street who consider themselves to be savvy would not even be able to tell you who the current U.S. Vice President might happen to be or who think that Abraham Lincoln was our first President.

Then there are those who excel in steadfastly or purposefully remaining ignorant while, alas, being even proud of that fact. There is nothing worse than having to listen to someone mispronounce words, use words out of context, use an incorrect word, use a word that does not exist, misquote facts and figures, or vehemently argue a point that has no basis.

We also are beginning to excel in the domain of unreasonable expectations, which then lead to disappointing outcomes, and disappointing outcomes in our society has been translated into exacting revenge by excessive litigation.

We have become a society continuously plagued by personal injury suits while in becoming a people who never give a second thought to taking any responsibility for our own actions have sadly entered the golden era of the get rich quick schemes attached to the “legal lottery system.”

If you trip, fall and hurt yourself, the man whose business is located on that section of sidewalk must be to blame but not your own personal clumsiness or the fact of the distraction of talking on your cell phone causing you to not to pay attention to an irregular piece of brick or concrete.

If you spill hot McDonald’s coffee while holding it in your lap, it becomes a corporate liability for not specifically, and in bold print, warning you that boiling hot coffee could actually burn you if you let it spill on your crotch. It has nothing to do at all with your innate stupidity or your careless clumsiness.

One of the most inane cases I read about concerned a man who broke into a vacationer’s house, ransacked the place, filled up his rucksack with valuables and then got stuck in the garage in his attempt to exit. The door to the house had locked behind him and the garage door opener failed to work. He was forced to survive on a bag of dog food until the owners arrived several days later and then had him arrested. He successfully sued the homeowner for mental anguish and won $500,000 on the ruling that there should have been a better food selection and a better means of facilitating an escape. After all, he might have died in there.

Another case involved a burglar who was wounded in an entrance hallway by a homeowner who blasted him with a shotgun as he came through the door. The burglar succeeded in winning a lawsuit because the homeowner had not shouted a warning that he was armed. I suppose there should have been a sign outside stating: Beware of shotgun if you try to steal any of my shit.

Tell that one to the survivors of a home invasion victim who has been knifed to death.

My Loan Shark friend always cautioned me that if you have to actually shoot and kill a home intruder, be sure you not only finish him off, but also be sure you leave the body somewhere in the house. If you shoot him in the driveway for example, drag the body back inside or you might be arrested and convicted for a random homicide. Also never leave him wounded. That way; not only will he never come back for revenge or even sue you; but he cannot ever tell his side of the story. Everyone knows that live men often lie but dead men tell no tales. He also added  in the unlikely event of such occurrence:
“Just call me. I’ll send my kids over and we’ll  bury him in the woods.”

The best one of all is the case of the woman, who bought a brand new 32-foot Winnebago, set the cruise control for 70 mph on the Interstate and went in the back to the kitchen to make a sandwich. She survived the accident and won not only a brand new replacement vehicle, but also $1,750,000 in damages. The owner’s manual was not explicit enough about the true meaning of ‘auto-pilot.’

When I became a physician there was no real difference in the human behavioral patterns I had seen as a waiter, but at least at that point having to put up with it was far more lucrative than getting ten percent of a waitress’ tips. It’s just too bad there cannot be extra billable co-pays allowed for the diagnoses of “Chronic Nasty,” ‘Malignant Obnoxious,” or “Limitless Unreasonable Expectations.”

After thirty years of forced diplomacy and interpersonal burn-out I came to believe that, in theory, the best patient would be an orphan, presenting in a coma before any required personal interview would have to be extracted, who would then also would be intubated on a ventilator, unable to speak, heavily sedated, and by definition would have no family around to harass or make unreasonable demands. At least then I could actually get the work done required to save his life.

In a similar vein, the most fascinating thing in actually dealing with a nameless comatose patient becomes watching the person’s true personality emerge as he/she comes out of artificially induced maximum sedation while slowly transitioning from a completely dependent inert entity back to his/her original animated and uniquely independent personality. It is like watching an insect emerge from a cocoon, which always culminates as an unpredictable surprise. Sometimes you get a Monarch Butterfly, sometimes you get a Gypsy Moth, but then again sometimes you might even get a Scorpion or a Rattlesnake.

I have heard the philosophical line stated that; “When a doctor sees a man he does not see good or evil, but only sick or well.” That is only partially true. I have seen many sick people who I would still label as being really evil.

Then throw in the arena of Medical Malpractice where the sky becomes the ultimate limit.

Orthopedic surgeons get sued because they cannot re-make a shattered bone conform to God’s original blueprint.

Obstetricians get sued for birth trauma 18 years later because a child has a poor IQ. Not because the parents are mental midgets and the child by definition inherited an absence of cerebral cortex.

In fact, I was once sued because I could not save a mother who died giving birth because her lungs were suddenly filled with amniotic fluid. She died instantly of internal asphyxiation. Her fate was out of my control and although only God may have been able to save her, he was not in her room on that fateful day. Although the case was certainly tragic; it also happens to be a very rare but known natural complication of pregnancy; leaving me to doubt the husband would not even remotely think that he might be more to blame than me because he unknowingly had sent her to her doom the very instant he had inseminated her. ‘You pay your money and you take your chances.’

Making matters even worse, no one ever once said thanks for rescuing a viable baby who had no residual brain damage despite the fact that the mother was cold, blue and virtually un-oxygenated.

A malpractice defense attorney once told one of my colleagues that the only mistake he had made in dealing with what turned out later to be a thankless litigant; was not to have saved his life.

The attorney said he would have been better off just having let the ungrateful bastard die instead of getting him through his heart attack and back on his disabled feet again. One of the particulars of the case was that the victim was not able to get an erection anymore after his heart went sour. Wrongful death, you see, has less monetary value than “loss of conjugal company,” “loss of future income,” “pain and suffering,” or “emotional distress.” Dead is dead. But it is the intangibles in life that really count in court.

In retrospect, choosing a career that required no or little interpersonal interaction at all would probably have been best.

Anesthesia fits this description to a tee being a branch of medicine that is ninety-nine percent boredom, and one percent panicked crisis, but is at the same time an incredibly one hundred percent lucrative. One of my colleagues once facetiously stated, in mimed foreign dialect, that you also only have to know two key phrases in doing the job:

First before intuabtion:

  • Open your mouse. Open your mouse.

Then in the recovery room:

  • Vake up, vake up.

Obviously part of the job description is “No English required.”

I used to ask friends who were not physicians when they complained about business customers or clients and their various behaviors, how they would like to take care of these same people if they happened to be ill. The response would usually be the unmitigated sympathetic equivalent of “Oy vey.”

I failed to tell them that when people are really sick and know they are completely dependent on you for the safety and preservation of their lives that for the most part this dependence forces them to be fairly nice.

However, once the crisis is over and the lipstick, powder and rouge come out, all bets are then completely off as it then becomes time to run for the exits. In Medicine, we call this indicator of full recovery and o further necessity for hospital discharge, the “Lipstick sign.” On the contrary we were always wary of any patient presenting to the hospital carrying an overnight bag because in knowing they would say or do anything to be admitted, were revealing their intention with the” Suitcase sign.”

At this point in my life, after four unjustified malpractice lawsuits and over three decades of having to prostitute my personality, I truly envy anyone who has a job that only requires dealing with paper, ether, and the ether-net or with inanimate objects.

Investment Banking may have been the career suiting that bill. Not only is it a vocation that is relatively inert on requirements for intimate personal interactions, but it also tends to involve substantial financial rewards. The best of all, because of its intangible nature, nobody in truth seems to have a full grasp on what it actually is.

P.T. Barnum made a fortune by charging people twenty-five cents each to:



Thinking it to be some previously unknown exotic animal or sideshow freak, circus customers were led into then through an empty corridor and then out its back end. They could not litigate a refund. The sign was clear and truthful.

He also made a greater fortune by exhibiting Zip the Pinhead, an Afro-American with a congenitally odd shaped head, who was put in the freak sideshow where he was advertized as “the missing link.” William Henry Johnson, billed to the public as a dumb wild half-man found in the African jungle, was smart enough to play along as he made the equivalent of 3.2 million dollars for himself before he died.

His final words to his sister were:

  • Well we fooled ‘em for a long time, didn’t we?

The collective IQ of America’s general public has not really improved a great deal since the 1880s. Neither has its proclivity toward sloth, greed, ignorance, personal indifference or a mindset aimed at winning the lottery of your own personal choice.



“As soon as I get my moves more fluent; I’ll really be in the spice of things. But that’s a whole nother thing.”

(Quote from a college scholarship basketball player after having an “off” night. He will eventually go on to enjoy a multi-million dollar NBA contract.)

Lawsuits: ‘Stuck in the Garage’ and the ‘Winnebago:’ from the 2005 Stella Awards
Factual information on Zip the Pinhead taken from Wikipedia
© Basketball Players

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